1232 SELECTIVE TRANSARTERIAL EMBOLIZATION FOR POSTTRAUMATIC RENAL HEMORRHAGE: IS A SECOND TRY WORTHWHILE?

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery IV1 Apr 20101232 SELECTIVE TRANSARTERIAL EMBOLIZATION FOR POSTTRAUMATIC RENAL HEMORRHAGE: IS A SECOND TRY WORTHWHILE? Johannes Huber, Sascha Pahernik, Peter Hallscheidt, Nina Wagener, Axel Haferkamp, and Markus Hohenfellner Johannes HuberJohannes Huber More articles by this author , Sascha PahernikSascha Pahernik More articles by this author , Peter HallscheidtPeter Hallscheidt More articles by this author , Nina WagenerNina Wagener More articles by this author , Axel HaferkampAxel Haferkamp More articles by this author , and Markus HohenfellnerMarkus Hohenfellner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.755AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Selective percutaneous transarterial embolization (TAE) has proven to be an effective and safe treatment for traumatic renal hemorrhage when conservative measures fail. Although high success rates above 70% are reported further treatment escalation often leads to nephrectomy after inefficacious procedures. Therefore, success rates of interventional treatment should be maximized. METHODS Retrospectively, the present study investigated the clinical success rate of TAE in 19 cases of active posttraumatic bleeding from 2001 through 2009. Inclusion criteria were imaging evidence of hemorrhage and clinical signs of renal arterial injury or a hemoglobin-drop of more than 1.5 mmol/l. Median patient age was 68 (12-78) years. Etiology was blunt trauma (3), a stab wound (1) and iatrogenic causes (15). The latter were due to nephron sparing surgery (8), PCNL (3), SWL (1), open pyelotomy (1), and endoluminal renal artery stenting (1). Coil (15), liquid (8), and corpuscular (1) embolization was performed with a combination of more than one agent in 7 cases. Clinical course, hemoglobin development, and kidney function were analyzed. Clinical success of TAE was primary study goal. RESULTS In 10.5% (2/19) an active bleeding site could not be detected during selective angiography and these patients were hemodynamically stable afterwards. TAE was performed on day 2 median (0-35) and had a primary success rate of 64.7% (11/17). In 83.3% (5/6) of primary treatment failure, a second TAE took place on day 13 (7-47). The second TAE resulted in 60% (3/5) of clinical success. Overall success of interventional treatment was 82.4% (14/17). One contrast agent reaction occurred (5.9%). Three patients (17.6%) could not be sufficiently treated by TAE and underwent nephrectomy 19 (14-29) days after the initial trauma: The stab wound caused multiple lesions of smaller vessels and the collecting system. One patient had to be fully anticoagulated because of acute myocardial infarction following nephron sparing surgery, and the third case resulted from imperative resection of multiple tumors. CONCLUSIONS TAE is the first choice in traumatic renal hemorrhage whenever feasible. As there are similar success rates for the first and second intervention, another session is justified whenever the clinical course allows for it. Therefore, TAE is worth a second try. Heidelberg, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e476-e477 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Johannes Huber More articles by this author Sascha Pahernik More articles by this author Peter Hallscheidt More articles by this author Nina Wagener More articles by this author Axel Haferkamp More articles by this author Markus Hohenfellner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...